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Antibiotic treatment of children with sore throat
Jeffrey A Linder1, David W Bates, Grace M Lee
1Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA. jlinder@partners.org
Insights
Antibiotic prescribing for children with sore throat remains high, exceeding the prevalence of group A beta-hemolytic streptococci (GABHS). While GABHS testing can reduce antibiotic use in specific cases, it is underutilized in pediatric care.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Practice Guidelines
Background:
- Group A beta-hemolytic streptococci (GABHS) cause 15-36% of pediatric sore throats.
- GABHS testing before antibiotic prescription is recommended for children with sore throat.
- Recommended antibiotics for GABHS include penicillin, amoxicillin, erythromycin, and first-generation cephalosporins.
Purpose of the Study:
- To measure antibiotic prescribing and GABHS testing rates in children with sore throat.
- To evaluate the association between GABHS testing and antibiotic treatment decisions.
Main Methods:
- Analysis of data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1995-2003).
- Included visits by children aged 3-17 years with sore throat.
- Examined national rates of antibiotic prescribing, recommended/non-recommended antibiotic use, and GABHS testing.
Main Results:
- Antibiotics were prescribed in 53% of 7.3 million annual sore throat visits.
- Non-recommended antibiotics were given to 27% of children receiving antibiotics.
- GABHS testing was performed in 53% of visits and was associated with lower antibiotic prescribing for specific diagnoses (pharyngitis, tonsillitis, streptococcal sore throat).
Conclusions:
- Antibiotic prescribing for pediatric sore throat exceeds the expected prevalence of GABHS.
- A decrease in antibiotic prescribing from 1995-2003 was due to reduced use of recommended agents.
- GABHS testing is underutilized despite its association with reduced antibiotic prescribing in certain pediatric cases.
Context:
Of children with sore throat, 15% to 36% have pharyngitis caused by group A beta-hemolytic streptococci (GABHS). Performance of a GABHS test prior to antibiotic prescribing is recommended for children with sore throat. Penicillin, amoxicillin, erythromycin, and first-generation cephalosporins are the recommended antibiotics for treatment of sore throat due to GABHS.
Objectives:
To measure rates of antibiotic prescribing and GABHS testing and to evaluate the association between testing and antibiotic treatment for children with sore throat.
Design, Setting, And Participants:
Analysis of visits by children aged 3 to 17 years with sore throat to office-based physicians, hospital outpatient departments, and emergency departments in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1995 to 2003 (N = 4158) and of a subset of visits with GABHS testing data (n = 2797).
Main Outcome Measures:
National rates of antibiotic prescribing, prescribing of antibiotics recommended and not recommended for GABHS, and GABHS testing.
Results:
Physicians prescribed antibiotics in 53% (95% confidence interval [CI], 49%-56%) of an estimated 7.3 million annual visits for sore throat and nonrecommended antibiotics to 27% (95% CI, 24%-31%) of children who received an antibiotic. Antibiotic prescribing decreased from 66% of visits in 1995 to 54% of visits in 2003 (P = .01 for trend). This decrease was attributable to a decrease in the prescribing of recommended antibiotics (49% to 38%; P = .002). Physicians performed a GABHS test in 53% (95% CI, 48%-57%) of visits and in 51% (95% CI, 45%-57%) of visits at which an antibiotic was prescribed. GABHS testing was not associated with a lower antibiotic prescribing rate overall (48% tested vs 51% not tested; P = .40), but testing was associated with a lower antibiotic prescribing rate for children with diagnosis codes for pharyngitis, tonsillitis, and streptococcal sore throat (57% tested vs 73% not tested; P<.001).
Conclusions:
Physicians prescribed antibiotics to 53% of children with sore throat, in excess of the maximum expected prevalence of GABHS. Although there was a decrease in the proportion of children receiving antibiotics between 1995 and 2003, this was due to decreased prescribing of agents recommended for GABHS. Although GABHS testing was associated with a lower rate of antibiotic prescribing for children with diagnosis codes of pharyngitis, tonsillitis, and streptococcal sore throat, GABHS testing was underused.
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